CSP Exam Prep Course: Human Immunodeficiency Virus (HIV)

Comprehensive practice flashcards defining core vocabulary, antiretroviral regimens, classes, monitoring parameters, and clinical pearls for the NASP Certified Specialty Pharmacist (CSP) exam prep.

Immune Reconstitution Inflammatory Syndrome (IRIS)

An inflammatory condition resulting from increased T-cell activation following the start of antiretroviral therapy, most common in patients with high viral loads, low $CD4^+$ counts, and pre-existing opportunistic infections.

Elite Controllers

Individuals with HIV who can suppress viral replication through their own host immune response, maintaining undetectable or low HIV RNA levels and $CD4^+ > 500\text{ cells/}\mu\text{L}$ without therapy, though ART is still recommended due to chronic immune activation.

Acute HIV Infection

The early phase of HIV disease defined by detectable plasma HIV RNA or p24 antigen in the setting of a negative or indeterminate HIV antibody test result.

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

A foundational class of antiretrovirals that incorporates false nucleoside building blocks to inhibit HIV reverse transcriptase and cause viral DNA chain termination.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

A class of antiretroviral agents that allosterically bind to HIV reverse transcriptase to block polymerase activity and prevent the addition of new nucleosides.

Integrase Strand Transfer Inhibitors (INSTIs)

An antiretroviral class that blocks the integrase enzyme, thereby preventing the insertion and integration of viral DNA into the host cellular genome; noted for having the highest risk of weight gain among ARV classes.

Protease Inhibitors (PIs)

An antiretroviral class that inhibits the HIV protease enzyme, preventing the cleavage of viral polyproteins and halting the maturation of infectious virions.

Entry Inhibitors

A broad category of antiretrovirals (including attachment, post-attachment, coreceptor, and fusion inhibitors) designed to prevent HIV from attaching to, binding, or fusing with host $CD4^+$ cells.

HLA-B*5701 Screening

A pharmacogenetic test required prior to initiating abacavir therapy; patients testing positive are at high risk for severe, potentially fatal hypersensitivity reactions (HSR) and must never receive abacavir.

Coreceptor Tropism Testing

A molecular diagnostic assay required before prescribing maraviroc to ensure the patient's viral strain exclusively utilizes the CCR5 co-receptor for viral entry.

G6PD Deficiency Screening

An enzymatic laboratory assessment recommended for patients of African, Middle Eastern, Mediterranean, and Southeast Asian descent before initiating dapsone or primaquine for opportunistic infection prophylaxis.

Biktarvy

A coformulated single-tablet regimen containing bictegravir $50\,\text{mg}$, tenofovir alafenamide $25\,\text{mg}$, and emtricitabine $200\,\text{mg}$, taken once daily without food requirements; approved in virologically suppressed patients with M184V/I resistance and preferred in pregnancy.

Triumeq

A single-tablet regimen containing dolutegravir $50\,\text{mg}$, abacavir $600\,\text{mg}$, and lamivudine $300\,\text{mg}$, taken once daily without food requirements; requires negative HLA-B*5701 status before initiation.

Genvoya

A boosted single-tablet regimen containing elvitegravir $150\,\text{mg}$, cobicistat $150\,\text{mg}$, tenofovir alafenamide $10\,\text{mg}$, and emtricitabine $200\,\text{mg}$, taken once daily with food.

Stribild

A boosted single-tablet regimen consisting of elvitegravir $150\,\text{mg}$, cobicistat $150\,\text{mg}$, tenofovir disoproxil fumarate $300\,\text{mg}$, and emtricitabine $200\,\text{mg}$, taken once daily with food; only used in patients with $\text{CrCl} \ge 70\,\text{mL/min}$ and discontinued if $\text{CrCl} < 50\,\text{mL/min}$.

Dovato

A two-drug single-tablet regimen containing dolutegravir $50\,\text{mg}$ and lamivudine $300\,\text{mg}$, taken once daily; not recommended if HIV RNA $> 500{,}000\,\text{copies/mL}$, if HBV coinfection is present, or prior to receiving baseline resistance results.

Cabenuva

A complete long-acting intramuscular injectable regimen containing cabotegravir and rilpivirine, approved for monthly or every 2-month administration in virologically suppressed patients with an optional $4\text{-week}$ oral lead-in.

Juluca

A two-drug single-tablet maintenance regimen of dolutegravir $50\,\text{mg}$ and rilpivirine $25\,\text{mg}$, taken once daily with food, approved only for patients already virologically suppressed on another ARV regimen.

Symtuza

A protease inhibitor-based single-tablet regimen containing darunavir $800\,\text{mg}$, cobicistat $150\,\text{mg}$, tenofovir alafenamide $10\,\text{mg}$, and emtricitabine $200\,\text{mg}$, taken once daily with food.

Atripla

A coformulated NNRTI-based regimen consisting of efavirenz $600\,\text{mg}$, tenofovir disoproxil fumarate $300\,\text{mg}$, and emtricitabine $200\,\text{mg}$, taken once daily at bedtime on an empty stomach; no longer recommended as initial therapy.

Complera

A single-tablet regimen of rilpivirine $25\,\text{mg}$, tenofovir disoproxil fumarate $300\,\text{mg}$, and emtricitabine $200\,\text{mg}$, taken once daily with a meal; not recommended if baseline HIV RNA $> 100{,}000\,\text{copies/mL}$ or $CD4^+ < 200\,\text{cells/mm}^3$.

Odefsey

A coformulated NNRTI-based regimen containing rilpivirine $25\,\text{mg}$, tenofovir alafenamide $25\,\text{mg}$, and emtricitabine $200\,\text{mg}$, taken once daily with a meal; contraindicated with proton pump inhibitors (PPIs).

Delstrigo

A single-tablet regimen combining doravirine $100\,\text{mg}$, tenofovir disoproxil fumarate $300\,\text{mg}$, and lamivudine $300\,\text{mg}$, taken once daily without regard to food.

Epzicom

A dual-NRTI backbone combination tablet containing abacavir $600\,\text{mg}$ and lamivudine $300\,\text{mg}$, taken once daily.

Tenofovir Disoproxil Fumarate (TDF)

An NRTI prodrug associated with proximal renal tubulopathy (proteinuria, glycosuria, non-anion gap acidosis) and bone mineral density loss; risk is amplified when co-administered with a pharmacokinetic booster.

Tenofovir Alafenamide (TAF)

A targeted NRTI prodrug with improved renal and bone safety profiles compared to TDF, approved for $\text{eGFR} \ge 30\,\text{mL/min}$, but linked to greater weight gain and increases in LDL and triglycerides.

Abacavir Hypersensitivity Reaction (HSR)

A severe immunological reaction occurring at a median onset of $9\,\text{days}$ after starting abacavir therapy; characterized by fever, rash, GI, and constitutional symptoms, requiring immediate permanent discontinuation.

Nevirapine (NVP)

An NNRTI known for severe hepatotoxicity and skin rash (SJS/TEN); requires a $14\text{-day}$ lead-in titration that must be restarted from the beginning if treatment is interrupted for more than $7\,\text{days}$.

Atazanavir (ATV)

A protease inhibitor that inhibits UGT1A1 causing asymptomatic indirect hyperbilirubinemia and jaundice, as well as nephrolithiasis and cholelithiasis; requires gastric acidity for absorption.

Darunavir (DRV)

A potent protease inhibitor with a high genetic barrier to resistance that requires boosting with ritonavir or cobicistat, carries a sulfa moiety, and is associated with rash and higher cardiovascular risk than atazanavir.

Cobicistat (COBI)

A pharmacokinetic booster and CYP3A inhibitor with no intrinsic antiretroviral activity; should be avoided in pregnancy due to significantly lower drug exposures during the second and third trimesters.

Fostemsavir (FTR)

A first-in-class oral prodrug of temsavir that acts as a gp120 attachment inhibitor, indicated for heavily treatment-experienced patients with multidrug-resistant HIV experiencing virologic failure.

Ibalizumab (IBA)

A recombinant humanized monoclonal antibody that functions as a CD4-directed post-attachment inhibitor, administered intravenously every $2\,\text{weeks}$ for multidrug-resistant HIV.

Maraviroc (MVC)

An oral entry inhibitor that binds selectively to the human chemokine receptor CCR5, blocking gp120 interaction; dosed as $150\,\text{mg}$, $300\,\text{mg}$, or $600\,\text{mg}$ twice daily based on interacting concomitant medications.

Enfuvirtide (T-20)

A biomimetic peptide fusion inhibitor administered subcutaneously twice daily that binds to the HR1 region of gp41; associated with injection site reactions in $100\%$ of patients and an increased risk of bacterial pneumonia.

Lenacapavir (LEN)

A first-in-class multi-stage HIV-1 capsid inhibitor administered subcutaneously once every $6\,\text{months}$ (following oral loading) for the treatment of multidrug-resistant HIV infection.

Ryan White HIV/AIDS Program

A comprehensive federal safety-net program that provides medical care, medications, and essential support services to people with HIV who are uninsured or underinsured.

AIDS Drug Assistance Program (ADAP)

A state-administered component of the Ryan White Program providing financial resources, medication grants, and formulary access to ensure life-saving ARVs reach low-income and uninsured patients.

REPRIEVE Trial Statin Guidance

Clinical guidelines recommending moderate-intensity statins (pitavastatin $4\,\text{mg}$, atorvastatin $20\,\text{mg}$, or rosuvastatin $10\,\text{mg}$) in HIV patients aged $40\text{--}75$ with a $10\text{-year}$ ASCVD risk of $5\%\text{ to }<20\%$ to prevent cardiovascular events; simvastatin and lovastatin are contraindicated with boosted PIs.